<div class="row">
    <div class="col-xs-12">
        <div class="panel panel-midnightblue">
            <div class="panel-body">
                <form action="" class="form-horizontal row-border"  data-validate="parsley" id="validate-form">
                	<div class="row">
                		 <div class="form-group">
                    		<label class="col-sm-3 control-label" >选择会员:</label>
                    		<div class="col-sm-6">
                    			<input type="text" readonly="readonly" value="{$model.member_name}" class="form-control" />
                    		</div>
                   		 </div>
                   		 <div class="form-group">
                   		 	<label class="col-sm-3 control-label">课程名称</label>
                   		 	<div class="col-sm-6">
                   		 		<input type="text" readonly="readonly" value="{$model.course_name}" class="form-control" />
                   		 	</div>
                   		 </div>
                   		<div class="form-group">
                   		 	<label class="col-sm-3 control-label">剩余数量</label>
                   		 	<div class="col-sm-6">
                   		 		<input type="text" value="{$model.surplus}" readonly="readonly"  class="form-control" />
                   		 	</div>
                   		 </div>
                   		 
                   		 <div class="form-group">
                    		<label class="col-sm-3 control-label" >退款金额:</label>
                    		<div class="col-sm-6">
                    			<input type="text"   placeholder="退款金额"   required="required" value="0.0"  name="price" data-type = "money" class="form-control" id="price" />
                    		</div>
                   		</div>
                   		 <div class="form-group">
                   		 	<label class="col-sm-3 control-label">pt姓名</label>
                   		 	<div class="col-sm-6">
                   		 		<input type="text" value="{$model.pt_name}" readonly="readonly"  class="form-control" />
                   		 	</div>
                   		 </div>
    					<div class="form-group">
                   		 	<label class="col-sm-3 control-label">有效期开始</label>
                   		 	<div class="col-sm-6">
                   		 		<input type="text" value="{$model.start_date}" readonly="readonly"  class="form-control" />
                   		 	</div>
                   		 </div>
                   		 
                   		<div class="form-group">
                   		 	<label class="col-sm-3 control-label">有效期结束</label>
                   		 	<div class="col-sm-6">
                   		 		<input type="text" value="{$model.end_date}" readonly="readonly"  class="form-control" />
                   		 	</div>
                   		</div>
                   		 
                   		<div class="form-group">
                   		  	<label class="col-sm-3 control-label" >备注1:</label>
                    		<div class="col-sm-6">
                    			<textarea class="form-control" name="descs"></textarea>
                    		</div>
                   		</div>
                   		{notempty name="$model.order_date"}
                   		<div class="form-group">
                   			<div class="col-sm-6 col-sm-offset-3">
	                			<div class="alert alert-dismissable alert-danger">
	                				<strong>1.您还有预约，预约时间 {$model.order_date}</strong>
	                				<button type="button" class="close" data-dismiss="alert" aria-hidden="true">×</button>
	                			</div>
                			</div>
                   		</div>
                   		{/notempty}
                	</div>
                		
                	
                	
                	<input type="hidden" name="old_order_id"  value="{$model.id}"/>
                </form>
            </div>
            <div class="panel-footer">
                <div class="row">
                    <div class="col-sm-6 col-sm-offset-3">
                        <div class="btn-toolbar">
                            <button class="btn-primary btn" id="form-submit">提交</button>
                            <button class="btn-default btn" data-dismiss="modal">关闭</button>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>
<script type='text/javascript' src='{$Think.GYM_VIEW_JS}gym_pt_order/withdraw.js'></script>